Front Cover
IFC
Problem Solving in PEDIATRIC IMAGING
Problem Solving in PEDIATRIC IMAGING
Dedication
Contents
1 - Chest (Pulmonary/Cardiac)
1 - Imaging the Child With Respiratory Distress
“A” for “Airway”
“B” for “Bones”
“C” for “Cardiac” and Mediastinal Structures
“D” for “Diaphragm”
“E” for “Effusions”
“F” for Lung “Fields”
“G” for “Gastric” Bubble and “Gas” Pattern
“H” for “Hilum”
Differential Diagnosis of Respiratory Distress by Age
Toddler and Young Child
Airways
UPPER AIRWAY OBSTRUCTION
LOWER AIRWAY STRUCTURAL ABNORMALITY
Reactive Airways Disease/Asthma
Infection
Viral Bronchiolitis
Bacterial Pneumonia
Aspirated Foreign Body
Older Child and Adolescent
Community- Acquired Pneumonia
Acute Chest Syndrome
Cystic Fibrosis
Spontaneous Pneumothorax
Summary
2 - Mediastinal Masses
How Is the Mediastinum Subdivided?
What Normal Structures Occupy Each Compartment of the Mediastinum?
Anterior Mediastinum
What Is the Normal Appearance of the Thymus on Imaging Studies?
Where Can Ectopic Thymus Implant?
Thymic Hyperplasia
Thymic Cyst
Thymic Epithelial Tumors: Thymoma and Thymic Carcinoma
Thymic and Mediastinal Abscess
Thymolipoma
How Can Langerhans Cell Histiocytosis Manifest in the Mediastinum?
Germ Cell Tumors
Lymphoma
What Subtypes of Lymphoma Most Often Affect the Mediastinum?
How Is Lymphoma Staged?
What Is the Role of FDG- PET/CT in Lymphoma?
In Which Compartment Is Lymphoma Most Common?
Lymphatic Malformation
Middle Mediastinum
Vascular: Rings and Slings
Foregut Anomalies
Posterior Mediastinum
What Is the Origin of the Most Common Posterior Mediastinal Mass?
Nerve Sheath Tumors
What Patient Population Is at Risk for Malignant Peripheral Nerve Sheath Tumor?
Extramedullary Hematopoiesis
Summary
3 - Approach to Congenital Heart Disease
Morphological Identification of the Major Cardiac Segments
Atrial Identification
Visceroatrial Arrangement or Situs
Ventricular Identification
Ventricular Topology or Looping
Great Arterial Identification
Great Arterial Arrangement or Situs
Assessment of the Cardiac Segment Connections
Atrioventricular Connections
Ventriculoarterial Connections
Other Associated Lesions
Septal Defects
Atrial Septal Defects and Interatrial Communications
Morphology and Pathophysiology
Clinical Presentation
Imaging
Treatment
Ventricular Septal Defects
Morphology and Pathophysiology
Clinical Presentation
Imaging
Treatment
Atrioventricular Septal Defects
Morphology and Pathophysiology
Clinical Presentation
Imaging
Treatment
Select Outflow Tract Anomalies
Transposition of the Great Arteries
Morphology and Pathophysiology
Clinical Presentation
Imaging
Treatment
Tetralogy of Fallot
Morphology and Pathophysiology
Clinical Presentation
Imaging
Treatment
Double-Outlet Right Ventricle
Morphology and Pathophysiology
Clinical Presentation
Imaging
Treatment
Select Left Heart Lesions
Hypoplastic Left Heart Syndrome
Morphology and Pathophysiology
Clinical Presentation
Imaging
Treatment
Shone Complex
Morphology and Pathophysiology
Clinical Presentation
Imaging
Treatment
Aortic Arch Anomalies
Coarctation of the Aorta and Interrupted Aortic Arch
Morphology and Pathophysiology
Clinical Presentation
Imaging
Treatment
Vascular Rings
Morphology and Pathophysiology
Clinical Presentation
Imaging
Treatment
2 - Gastrointestinal
4 - Vomiting Infant
Bilious Vomiting Within the First 2 Days After Birth
Is the Obstruction Proximal or Distal?
MIDGUT MALROTATION
DUODENAL ATRESIA, STENOSIS, SHIFTENTERAND WEB
Distal Obstruction
JEJUNAL/ILEAL/COLONIC ATRESIA/STENOSIS
FUNCTIONAL IMMATURITY OF THE COLON
MECONIUM ILEUS
HIRSCHSPRUNG DISEASE
Bilious Vomiting in Older Infants and Children
Nonbilious Vomiting
Is the Vomiting Projectile and New in Onset (Suspected Pyloric Stenosis)?
Otherwise Healthy Infant (Suspected Uncomplicated Esophogreal Reflux)
Imaging Techniques
Abdominal Radiograph
Upper Gastrointestinal Series
In the Setting of Bilious Vomiting
Problems and Pitfalls
In the Setting of Nonbilious Vomiting
Contrast Enema
Abdominal Ultrasound
To Assess Midgut Malrotation and Volvulus
To Assess Gastroesophageal Reflux
To Assess Pyloric Stenosis
Pitfalls When Assessing the Pylorus With US
Summary
5 - Pediatric Abdominal Pain
How to Approach the Abdominal Radiograph in Pediatrics
How to Describe the Overall Gas Pattern
Normal Gas Pattern
Ileus
Obstruction
Age- Based Differential Considerations
Infants Beyond the Neonatal Period
Toddlers and School- Age Children
Older Children and Teenagers
Common Diagnostic Etiologies for Abdominal Pain Across Age Groups
Malrotation With Midgut Volvulus
Colonic Volvulus
Intussusception
Appendicitis
Gastroenteritis
Meckel Diverticulum
Mesenteric Adenitis
Urinary Tract Infection
Pneumonia
Pancreatitis
Henoch- Schönlein Purpura
Hemolytic Uremic Syndrome
Inflammatory Bowel Disease
Trauma
Constipation
Summary
6 - [AU6] - Abdominal Masses in Children
How Should a Differential Diagnosis Be Approached?
Abdominal Masses in Neonates/Infants
Renal Masses: Hydronephrosis, Cystic Renal Diseases, and Renal Neoplasms
Hydronephrosis
Cystic Renal Diseases
Renal Neoplasms
Adrenal Masses
Ovarian and Uterine Masses
Gastrointestinal Tract Masses
Hepatobiliary Masses: Infantile Hepatic Hemangiomas, Hepatoblastomas, Mesenchymal Hamartomas, and Choledochal Cysts
Infantile Hepatic Hemangioma
Hepatoblastoma
Mesenchymal Hamartoma of the Liver
Choledochal Cyst
Bowel- Related Masses: Enteric Duplication Cysts and Meconium Pseudocysts
Enteric Duplication Cyst
Meconium Pseudocyst
Miscellaneous Abdominal Masses
Lymphatic Malformations
Infradiaphragmatic Pulmonary Sequestration
Sacrococcygeal Teratoma
Abdominal Masses in Children Older Than 1 Year
Renal Masses
Neuroblastoma
Hepatic Masses: Hepatoblastoma, Hepatocellular Carcinoma, Undifferentiated Embryonal Sarcoma, and Angiosarcoma
Germ Cell Tumors
Rhabdomyosarcoma and Other Sarcomas
Lymphoma
3 - Genitourinary
7 - Scrotal Pain and Swelling
Ultrasound Examination Protocol
What Should I Do If I Cannot Document Flow in the Testicles of a Small Child?
Anatomy and Normal Ultrasound Appearance
Diagnostic Work up
Image Interpretation
Does the Patient Have Pain?
Twisted Spermatic Cord
Nontwisted Spermatic Cord With Normal Testicular Vascularity
Nontwisted Spermatic Cord and Increased Vascularity
Nontwisted Spermatic Cord and Decreased Vascularity
Painless Scrotal Swelling
Extratesticular Cystic Lesions
Extratesticular Solid Lesions
Intratesticular Cystic Lesions
Intratesticular Solid Lesions
Summary
8 - Imaging Approach to Urinary Tract Dilation
Ultrasound
Dynamic Renal Scintigraphy
Magnetic Resonance Urography
Tests for Vesicoureteral Reflux: Voiding Cystourethrogram, Radionuclide Cystogram, and Contrast- Enhanced Voiding Urosonography
Computed Tomography
Differential Diagnosis and Treatment
Hydronephrosis: Ureteropelvic Junction Obstruction (UPJO)
Hydroureteronephrosis: Obstruction, Reflux, or Both
Duplex Kidneys, Ectopic Ureters, and Ureteroceles
Bladder Outlet Obstructions: Neurogenic Bladder, Posterior Urethral Valves, a Posterior Urethral Valve Mimic, and Prune Belly Sy...
Acknowledgments
9 - Pelvic Pain
What to Do With an Ovarian Cyst?
When to Suspect Ovarian Torsion
What to Do With a Paraadnexal Cyst
Imperforate Hymen and Müllerian Duct Anomalies
Pelvic Inflammatory Disease
Ectopic Pregnancy
What to Do With Chronic Pelvic Pain
Endometriosis
Pelvic Congestion
Summary
4 - MSK
10 - Imaging the Limping Child
What Is the Utility of Radiographs?
What Is the Utility of Sonography?
Is There a Role for Bone Scans?
Is There a Role for Computed Tomography?
When to Consider Magnetic Resonance Imaging?
How Does the Patient’s Age Affect Imaging Work up?
How to Image a Child With Suspected Trauma
Radiographs in the Setting of Trauma
Suspected Trauma in Newly Ambulating Child: The Toddler Fracture
What to Do in Young Children With Suspected Trauma but Unreliable Histories?
How to Image a Child With Suspected Infection
How to Approach a Child With No History of Trauma and No Signs of Infection
How to Approach a Child With Subacute or Chronic Limp
Does the Presence of Pain Help?
What Conditions Present With Pathological Fractures?
Summary
11 - Skeletal Dysplasias
Extremities: Dysplasias With Prominent Diaphyseal Involvement
Extremities: Dysplasias With Prominent Metaphyseal Involvement
Extremities: Dysplasias With Prominent Epiphyseal Involvement
Skeletal Dysplasias With Thoracic Involvement
Skeletal Dysplasias With Pelvic Involvement
Skeletal Dysplasias With Major Involvement of the Spine
Skeletal Dysplasias With Extraosseous Organ Involvement
Skeletal Dysplasias With Decreased Bone Mineral Density
Skeletal Dysplasias With Increased Bone Mineral Density
Mimickers of Skeletal Dysplasias
Summary
12 - Approach to Pediatric Foot
Technique
Basic Anatomy
The Normal Foot: Lines and Positions to Know
Terminology
Heel Terminology
Equinus Position
Calcaneus Position
Hindfoot Terminology
Valgus
Varus
Plantar Arch Terminology
Forefoot Terminology
Adduction (Varus) and Abduction (Valgus)
Inversion (Forefoot Varus and Supination) and Eversion (Forefoot Valgus and Pronation)
Important Pathologies and Radiographic Findings
Congenital Talipes Equinovarus (Clubfoot)
Metatarsus Adductus
Skewfoot
Flatfoot (Planovalgus)
Congenital Vertical Talus
Tarsal Coalition
Summary
13 - Approach to Pediatric Elbow
What Are the Standard Radiographic Views of the Pediatric Elbow?
When Are Additional Views Helpful?
When Are Other Imaging Modalities Useful?
Part 2: Approach to the Pediatric Elbow Radiograph: FOOL Checklist
F: Fat Pads: Joint Effusion = Fracture (Most Likely)
What Is the Significance of the Posterior Fat Pad Sign?
What Is the Significance of the Anterior Fat Pad?
What If Positive Fat Pad and No Fracture Line Is Identified?
O: Overt Findings and Outlines
O: Ossification Centers
What Is the Significance of CRITOE?
When Is CRITOE Most Useful?
Are There Any Variants of CRITOE?
L: Lines
What Is the Anterior Humeral Line?
What Is the Radiocapitellar Line?
Are There Any Exceptions to the Anterior Humeral Line?
Are There Any Exceptions to the Radiocapitellar Line?
Part 3: Acute Pediatric Elbow Injuries
Radial Head Subluxation (Nursemaid’s Elbow)
What Is the Role of Imaging in Radial Head Subluxation? What If the Clinician Suspects Radial Head Subluxation But the Radiograp...
Can Radial Head Subluxation Occur in Infants 6 Months and Younger?
Common Pediatric Elbow Fractures
Supracondylar Fracture Overview
Lateral Condyle Fracture Overview
Medial Epicondyle Fracture Overview
Radial Neck Fracture Overview
Less Common Pediatric Elbow Fractures
Transphyseal Distal Humerus Fracture Overview
Radial Head Fracture Overview
Olecranon Fracture Overview
Pediatric Elbow Dislocation
Posterior Dislocation Overview
Radial Head Dislocation Overview
Which Fractures Should Raise Suspicion of an Associated Dislocation?
Part 4: Congenital and Posttraumatic Deformities Worth Mentioning
What Is Congenital Proximal Radioulnar Synostosis?
What Is the Supracondylar Process?
What Is the Fishtail Deformity?
Part 5: Chronic Elbow Injuries in the Athletic Child
What Is Little League Elbow?
Little League Elbow, Medial Compartment: Medial Epicondylitis/Apophysitis
Is “Little League Elbow” Seen in Other Sports?
Lateral Compartment: Juvenile Osteochondritis Dissecans
What Is Juvenile Osteochondritis Dissecans?
What Other Sports Predispose Adolescent Athletes to Osteochondritis Dissecans of the Elbow?
Posterior Compartment: Persistence of the Olecranon Physis
What Is Panner Disease?
Summary
14 - Imaging Approach to Pediatric Bone Lesions
Patient Age
Infants and Toddlers (<5 Years of Age)
Children (5–10 Years of Age)
Adolescents (10–20 Years of Age)
Host Bone
Longitudinal Plane of the Host Bone
Axial Plane of the Host Bone
Host Bone Reaction
Legion Margins/Patterns of Bone Destruction
Matrix and Mineralization
Soft Tissue Component
Single or Multiple Lesions
Infants and Toddlers (<5 Years of Age)
Acute Leukemia
Multifocal Langerhans Cell Histiocytosis
Metastatic Neuroblastoma
Osteomyelitis
Infantile Myofibromatosis
Osteofibrous Dysplasia
Children (5–10 Years of Age)
Ewing Sarcoma
Monostotic Langerhans Cell Histiocytosis
Adolescents (10–20 Years of Age)
Osteosarcoma
Primary Lymphoma of Bone
Osteochondroma
Fibrous Dysplasia
Chondroblastoma
Enchondroma
Fibroxanthomas (Fibrous Cortical Defect/Nonossifying Fibroma)
Chondromyxoid Fibroma
Distal Femoral Avulsive Irregularity
Osteoid Osteoma/Osteoblastoma
Periosteal (Juxtacortical) Chondroma
Unicameral Bone Cyst
Aneurysmal Bone Cyst
Summary
15 - Vascular Malformations
Simple Vascular Malformations
Capillary Malformations
Lymphatic Malformations
Venous Malformations
Arteriovenous Malformations
Arteriovenous Fistulas
Combined Vascular Malformations
Anomalies of Major Named Vessels
Vascular Malformations Associated With Other Vascular Anomalies
16 - Approach to Pediatric Soft Tissue Masses
Who Needs Imaging?
Problem Solving: Which Modality? Which Protocol?
Articular/Periarticular Mass
Is the Mass Cystic?
Does the Mass Enhance With a Gadolinium Contrast Agent?
Muscle
Are There Calcifications?
Presentation With Torticollis?
Was the Lesion Present at Birth?
Is the Lesion Rapidly Growing?
Nerve or Nerve Sheath
Skin and Subcutaneous Fat
Is There a History of Trauma?
Does It Contain Fat?
Is It a High- Flow Vascular Lesion?
Is It a Slow- Flow Vascular Lesion?
Summary
17 - MSK Trauma
Plain Radiographs
Ultrasound
Computed Tomography
Magnetic Resonance Imaging
Pediatric Bone Anatomy
Particularly Pediatric Fractures
Plastic Deformation
Buckle
Greenstick Fracture
Complete Fracture
Physeal Fractures
Pearls and Pitfalls
How Can We Tell Abusive Fractures From Accidental Injury?
Normal Variants Not to Be Confused for Fracture
Summary
5 - General
18 - Imaging of the Neonate: Preterm Infant
Lines and Tubes in the Neonatal Intensive Care Unit
Umbilical Venous Catheter
Umbilical Arterial Catheter
Chest
How to Approach Lung Opacities in the Preterm Infant?
Respiratory Distress Syndrome
Air Leak Complications in Respiratory Distress Syndrome
Neonatal Chronic Lung Disease
Patent Ductus Arteriosus
Gastrointestinal
What to Look Out for in a Preterm Infant Abdominal Radiograph?
Necrotizing Enterocolitis
Brain
Head Ultrasound Technique
What to Look for in a Preterm Head Ultrasound?
Germinal Matrix Hemorrhage
Summary
19 - Imaging of the Neonate: Term Infant
How Do I Know If My Radiograph Is Technically Adequate for Diagnosis?
Collimation
Projection/Angulation
Positioning
Respiration
Exposure
Is That Normal?
Humeral Ossification Centers
Broken Clavicle
Tracheal Buckling
Troubleshooting a Narrowed- Appearing Airway
Heart and Mediastinum: Is It Enlarged? Or Is It All Thymus?
Pitfalls in Imaging Lungs: Normal Findings
Approach to Pulmonary Vascularity
Diffuse Granular Hazy Appearance: What Should I Be Thinking Of?
Reticular Pattern: What Should I Be Thinking Of?
Entities Relating to Altered Fluid Dynamics
Entities Related to Infection
Meconium Aspiration Syndrome
Interstitial Lung Disease
Congenitally Hyperlucent Lung: Differential?
Asymmetrical Smaller Lung: What Should I Be Thinking Of?
When There Is Pulmonary Artery Abnormality
When There Is Pulmonary Venous Abnormality
Characteristic- Appearing Neonatal Lesions of the Lung
Congenital Pulmonary Airway Malformation
Bronchopulmonary Sequestration
Congenital Diaphragmatic Hernia
Esophageal Atresia With or Without Tracheoesophageal Fistula
Abdomen
Obstructed Bowel
Pitfalls of Plain Film
Highly Specific Findings on the Abdominal Radiograph
Postnatal Workup of a Prenatally Diagnosed Abdominal Cyst
Summary
20 - Abusive Head and Spinal Trauma
Demographics, Clinical Presentation, and Outcomes
What Is Abusive Head Trauma?
How Common Is AHT?
What Are the Classic Features of AHT?
Which Signs and Symptoms May Be Observed in a Child with AHT?
Are There Certain “Red Flags” That Should Alert the Clinician to the Possibility of Abuse in a Child With Neurological Deficits?...
What Other Causes of Traumatic Head Injury Are There in Very Young Children Other Than Abuse?
What Are the Proposed Mechanisms of Injury in Cases of AHT?
Are There Certain Triggers That May Contribute to a Caretaker Intentionally Injuring a Child?
Is There a Specific Age Range or Type of Child That Is at Increased Risk for AHT?
When AHT Is Missed by a Healthcare Professional, What Are the Most Common Alternatively Entertained Diagnoses?
How Often Is AHT Misdiagnosed by Healthcare Professionals?
How Is the Nature of Injury Established in Cases of Suspected AHT?
What Is the Composition of a Multidisciplinary Child Protection Team?
What Is the Role of the Radiologist in Evaluating Children With Suspected AHT?
What Are the Potential Clinical Outcomes for Children With AHT?
Imaging of AHT
Are There Imaging Patterns That Are Considered Particularly Suggestive of AHT?
Skull Fractures
What Is the Most Common Type of Skull Fracture in AHT?
Subdural and Epidural Hematomas
What Causes Subdural Hematomas in Children With AHT?
What Is the Typical Appearance of a Subdural Hematoma in a Child With AHT?
How Do Hematohygromas Form?
What Are the Causes of Heterogeneous-Appearing Subdural Hematomas on CT in Children With AHT?
What Does a Membrane Within a Subdural Hematoma Signify?
Should I Attempt to Date a Subdural Hematoma in My Report Based on Imaging Characteristics?
Why Does the Clinician Want to Know the Age of an Imaging Abnormality in Cases of Abuse?
How Common Are Subdural Hematomas After Birth, and How Long Are They Evident on Imaging?
What Do Enlarged Low-Density Extraaxial Spaces in the Frontal Region on Imaging Represent in Infants?
Are Retroclival Subdural or Epidural Collections Commonly Seen in Cases of AHT?
Are Convexity Epidural Hematomas Common in Cases of AHT?
Subarachnoid and Intraventricular Hemorrhage
Is Subarachnoid or Intraventricular Hemorrhage Common in AHT?
Parenchymal Brain Injury
Which Types of Parenchymal Injury Are Seen in AHT?
What Is the Imaging Appearance of HII in Children With AHT?
Regarding Parenchymal Hemorrhages, Is There a Distinctive Appearance in Children With AHT?
Are Parenchymal Contusions Observed in AHT?
What Are Cerebral Contusional Tears?
What Type of Posterior Fossa Abnormalities Are Seen on Imaging in AHT?
Retinal Hemorrhages
How Common Are Retinal Hemorrhages in Children With AHT, and Can They Be Detected on Imaging?
Skull Fractures
Differential Diagnosis
WHICH MEDICAL CONDITIONS CAN CAUSE INTRACRANIAL SDHS?
Imaging Strategies in the Evaluation of AHT
If AHT Is Suspected in a Child, What Is My First-Line Imaging Study of Choice?
Are Computed Tomography Sagittal and Coronal Reformatted Images Helpful in Cases of AHT?
Is a Computed Tomography Three-Dimensional Bone Model of the Skull Helpful in Cases of Head Trauma?
In Cases of Suspected AHT, Should I Recommend Brain Magnetic Resonance Imaging to Follow Computed Tomography of the Head?
Should I Administer Gadolinium in Cases of Suspected AHT?
Is There a Role for Head Ultrasonography in Children With AHT?
Should I Recommend Follow-Up Head Imaging in a Child With Suspected AHT?
Abusive Spine Trauma
Demographics, Clinical Presentation, and Outcomes
Are Spinal Fractures Common in Cases of Abuse?
Why Are Spinal Injuries Often Clinically Silent in Abused Children?
What Are the Mechanisms of Injury in Abusive Spinal Trauma?
What Are the Clinical Outcomes for Children With Abusive Spinal Injury?
Imaging of Abusive Spine Trauma
Which Types of Spinal Injury Are Encountered in Cases of Abuse?
What Other Types of Spinal Fractures Should I Be Looking For?
Are Spinous Process Fractures Detectable on the Skeletal Survey?
Spinal Cord and Soft Tissue Injury
What Types of Spinal Cord Injury Are Found in Cases of Abuse?
Are Soft Tissue and Ligamentous Injuries of the Spine Common in Abused Children?
What Is the Significance of Myositis Ossificans in Children With Abusive Spine Trauma?
Subdural and Epidural Hematomas
Differential Diagnosis
Imaging Strategies of Abusive Spine Trauma
Summary
21 - Child Abuse (Radiology)
Fractures Associated With Child Abuse and Fracture Dating
Soft Tissue Injuries in Child Abuse
American College of Radiology Criteria
Differential Diagnosis of Skeletal Injuries
Accidental Injuries
Normal Variants
Birth Trauma
Cardiopulmonary Resuscitation
Rickets
Osteogenesis Imperfecta
Scurvy
Copper Deficiency
Infections
Periostitis and Child Abuse
Periostitis Differential Diagnoses
Summary
22 - Dose Optimization and Risk Management in Pediatric CT
How Does Radiation Damage the Cell?
Why Is Radiation a Greater Concern in Children Than in Adults?
What Evidence Is There to Support Carcinogenic Effects Associated With Ionizing Radiation?
Fundamentals of CT Dosimetry
What Is the Radiation Dose for a CT Scan?
CT Dose Index
Dose Length Product
Size- Specific Dose Estimate
Effective Dose
Dose and Image Quality Targets
What Is an Appropriate CT Dose?
CT Protocol Design
How Can I Create Pediatric CT Protocols?
Advanced Topics
What Is Tube Current (mA) and Rotation Time (mS), and How Do They Affect Patient Dose?
What Is Kilovolt Peak, and How Does It Affect the Patient Dose?
What Are Acceptable Kilovoltage Ranges for Imaging of Children?
What Is Pitch, and How Does It Affect the Patient Dose?
What Are the Advantages of Higher Pitch?
Automatic Exposure Control
What Is Iterative Reconstruction, and How Does It Compare With Filtered Backprojection?
Communicating Risk
How Should I Communicate the Risk and Benefits to a Parent or Patient?
What Challenges Will I Face in Discussing Radiation Risks With Patients?
How Should I Discuss Dose?
How Should I Discuss Risk?
Summary
6 - Fetal
23 - Fetal Body MRI
When Should Fetal Magnetic Resonance Imaging Be Performed?
How Is Fetal Magnetic Resonance Imaging Performed?
How Should the Patient Be Prepared?
What Is the Fetal Magnetic Resonance Imaging Protocol?
Should Intravenous Contrast Be Given for Fetal Magnetic Resonance Imaging?
Approach to Interpretation
What Maternal Structures Should Be Assessed?
What Is the Fetal Situs?
Fetal Face and Neck
What Is the Normal Appearance of the Fetal Face and Neck?
What Can Fetal Magnetic Resonance Imaging Add to the Diagnosis of Cleft Lip and/or Palate?
What Can Fetal Magnetic Resonance Imaging Add to the Diagnosis of Micrognathia?
What Neoplasms and Masslike Malformations Can Be Found in the Face and Neck?
Fetal Thorax
What Does the Normal Fetal Thorax Look Like on Magnetic Resonance Imaging?
What Is the Significance of Diffuse T2 Hyperintensity in the Lungs?
What Is the Significance of Focal Signal Abnormalities in the Lungs?
What Might Be the Significance of Pleural Effusions?
If a Congenital Diaphragmatic Hernia Is Present, What Should Be Evaluated?
WHERE IS THE LIVER?
IS A HERNIA SAC PRESENT?
WHAT ARE THE FETAL LUNG VOLUMES?
ARE THERE OTHER ANOMALIES?
Can Magnetic Resonance Imaging Help Determine Whether the Fetal Thorax Is Small?
What Might It Mean If the Heart Is Abnormally Positioned?
Can Esophageal Atresia Be Diagnosed by Fetal Magnetic Resonance Imaging?
Fetal Abdomen and Pelvis
What Do the Normal Gastrointestinal System Structures Look Like by Fetal Magnetic Resonance Imaging?
What Do the Normal Genitourinary System Structures Look Like?
What Is the Differential Diagnosis for a Suprarenal Mass?
An Upper Abdominal Cystic Mass Is Present, What Might This Be?
Can Distal Bowel Obstruction Be Diagnosed Prenatally?
What Is the Spectrum of Abdominal Wall Abnormalities, and What Should Be Reported?
What Do Large Kidneys Signify?
What Is the Best Approach for the Evaluation of Hydronephrosis?
WHAT IS THE SEX OF THE FETUS?
ARE THE URETER(S) AND/OR BLADDER DILATED?
IS THE HYDRONEPHROSIS UNILATERAL OR BILATERAL?
What Might a Cystic Mass in the Lower Abdomen or Pelvis Be?
What Is the Differential Diagnosis for a Presacral Mass?
What Other Visceral Abdominopelvic Neoplasms May Present in Fetal Life?
IN THE LIVER
IN THE KIDNEY
Fetal Musculoskeletal System
Is Magnetic Resonance Imaging Useful in Evaluating the Fetal Musculoskeletal System?
Is There a Role for Magnetic Resonance Imaging in the Evaluation of Skeletal Dysplasias?
How Might Magnetic Resonance Imaging Aid the Assessment of Fetal Clubfoot?
What Soft Tissue Tumors May Be Encountered in the Musculoskeletal System?
Multifetal Gestations
What Is the Role of Magnetic Resonance Imaging in Multifetal Gestations?
Summary
24 - Fetal CNS MRI
At What Gestational Age Is Fetal Central Nervous System Magnetic Resonance Imaging Best Performed?
What Are Common Indications for Fetal Central Nervous System Magnetic Resonance Imaging?
What Protocol Should Be Used to Evaluate Fetal Central Nervous System Abnormalities?
Fetal Central Nervous System: Normal Development
What Is the Initial Approach to Evaluating the Fetal Brain on Magnetic Resonance Imaging?
Ventriculomegaly
What Is the Value of Fetal Magnetic Resonance Imaging in Evaluating Ventriculomegaly?
How Do I Decide if the Ventriculomegaly Is Obstructive or Nonobstructive?
Is the Corpus Callosum Normal?
Are the Right and Left Cerebral Hemispheres and the Central Gray Matter Fully Divided?
Is the Cavum Septum Pellucidum Present?
Are There Small or Large Portions of the Lobar Cerebral Brain Parenchyma That Are Not Present?
Are There Regions of Cortical Irregularity or Abnormal Layering and/or Dissimilarity to the Contralateral Side?
Is One Ventricle Larger Than the Other?
Are the Ventricle Margins Smooth and of Normal Signal Intensity?
Is There a Solid and Cystic Intracranial Mass?
Posterior Fossa
Is There Cystic Enlargement of the Posterior Fossa?
Does the Cystic Enlargement of the Posterior Fossa Communicate With the Fourth Ventricle?
Is There Elevation of the Torcular Herophili?
Is the Vermis Normal?
Are the Cerebellar Hemispheres Too Small?
Are the Cerebellar Hemispheres Fused?
Does the Brainstem Have a “Kinked” Appearance?
Vascular
Are There Abnormal Intracranial Flow Voids (e.g., Flow Voids That Are Too Large and/or Are Increased)?
Is There a Vascular Nidus?
Complication of Monochorionic Twin Pregnancy
Are There Regions of Brain Destruction in a Monochorionic Pregnancy in the Living Fetus After One Fetus Dies?
Head and Neck
Is There a Midline Cystic Scalp Lesion?
Is One or Both Globes Absent or Too Small?
Is the Interocular or Binocular Distance Abnormal?
Is There a Defect in the Upper Lip or Palate?
Does the Mandible Appear Recessed or Too Small?
Is a Cystic Head and Neck Mass Midline or off Midline?
Does a Neck Mass Have Flow Voids?
Are There Solid and Cystic Components?
Spine
Is There an Open Defect in the Lower Spine?
Does the Spine Abruptly Stop Before the Coccyx?
Is There a Segment of the Spine That Is Absent?
Is There a Fluid- Filled Sac Anterior to the Sacrococcygeal Spine Separate From the Bladder?
Summary
7 - Brain
25 - Pediatric Head CT
Computed Tomography Techniques and Radiation Awareness
Special Computed Tomography Examination Considerations
Key Imaging Questions
Are the Vascular Structures Hyperdense?
Sinovenous Thrombosis
Acute Arterial Stroke
Is There Cerebral Edema?
Is There Mass Effect/Midline Shift or Herniation?
Are the Ventricles Too Big?
Are the Cerebrospinal Fluid and Extraaxial Spaces Normal?
Is There Intraparenchymal Hemorrhage?
Are the Midline Structures Intact?
Are There Intracranial Calcifications?
Are There Foreign Bodies?
Are There Any Abnormal Masses Associated With the Skull or Soft Tissues?
Summary
8 - Head and Neck
26 - Approach to Lateral Neck Radiographs
Technique
How to Read the Lateral View
Tonsils and Adenoids
Epiglottis
Subglottic Airway
Prevertebral Soft Tissues
“Edge of Film” Findings
Case Examples
Adenoid and Tonsillar Enlargement
Retropharyngeal Abscess
Epiglottitis
Croup
Bacterial Tracheitis
Foreign Bodies
Miscellaneous
Congenital Lesions
Neoplasm
Accidental and Iatrogenic Causes
Autoimmune Diseases
Summary
27 - Pediatric Head and Neck Masses
Ocular Masses
Is There a Mass Involving the Retina With Calcifications?
Is There a Mass Involving the Retina Without Calcifications?
Is the Mass Retrolental?
Does the Mass Involve the Iris?
Is the Vitreous Abnormal Without a Discrete Mass?
Is There Retinal Detachment?
Is There a Mass Involving the Optic Nerve?
Extraocular Masses
Is the Mass Cystic and Unilocular?
Is There a Unilocular Cystic Lesion Near the Medial Canthus?
Is There a Unilocular Cystic Lesion That Is in Continuity With the Globe?
Is the Lesion Multicystic?
Is the Mass Solid and Hypervascular?
IS THE MASS IN THE BONY ORBIT?
IS THE MASS CENTERED IN THE BONE OF THE LATERAL ORBITAL WALL WITH AN AGGRESSIVE PERIOSTEAL REACTION?
IS THERE A CLINICAL HISTORY OF LEUKEMIA?
IS THERE AN EXPANSILE, GROUND-GLASS APPEARANCE TO THE BONY ORBIT?
Part 2: Sinonasal Masses (Box 2)
Nasofrontal Masses
Is the Mass Continuous With the Brain Through a Cranial Defect?
Is the Mass Discontinuous With Brain Tissue?
Is There a Persistent Sinus Tract or Inclusion Cyst?
Is the Mass Hypervascular?
Sinus Masses
Is the Mass Polypoid and Protruding Into the Nasopharynx Without Aggressive Features?
Is There an Aggressive-Appearing Mass at the Roof of the Nasal Cavity?
Is the Mass Osseous Based, With a Mixed Lytic and Sclerotic Appearance?
Nasopharynx Masses
Is There a Soft Tissue Mass With Aggressive Features?
Is the Patient Male With the Mass Centered on the Sphenopalatine Foramen?
Is There an Aggressive-Appearing Mass Involving the Lateral Nasopharyngeal Wall?
Part 3: Oral Cavity, Floor of Mouth, and Mandibular Masses (Box 3)
Oral Cavity Masses
Is the Lesion Cystic and near the Vallecula?
Floor of Mouth Masses
Is the Lesion Cystic and Midline?
Is the Lesion Cystic and Lateral to Midline?
Is There a Cystic Collection Associated With Dental Disease?
Mandibular Masses
Is It an Aggressive-Appearing Lesion Centered on Bone?
Is It an Aggressive Soft Tissue Mass Involving Bone?
Is the Lesion Sclerotic and Well Circumscribed?
Is It a Lucent Lesion With Multifocal Mineralization?
Is the Lesion Cystic?
Is the Cyst Periapical?
Is the Cyst Expansile Without Erosion of Adjacent Teeth?
Is the Cyst Unilocular and Expansile With Erosion of Adjacent Teeth?
Is the Cyst Multilocular and Expansile With Erosion of Adjacent Teeth?
Does the Lesion Resemble Small, Malformed Teeth?
Is There an Expansile, Ground-Glass Appearance to the Mandible or Maxilla?
Is There Resorption of the Bone Around Multiple Teeth?
Part 4: Neck Masses (Box 4)
Anterior Neck Masses
Is the Lesion Cystic?
Is the Cyst Midline?
Is the Cyst Lateral to Midline?
THE BRANCHIAL APPARATUS AND THEIR REMNANTS
IS THE LESION IN THE LATERAL NECK?
IS THE LESION CLOSELY ASSOCIATED WITH THE UPPER POLE OF THE THYROID GLAND?
IS THE CYST NEAR THE LOWER NECK ON THE LEFT?
IS THE LESION ADJACENT TO A FOREGUT STRUCTURE?
DOES IT INVOLVE THE THYROID?
IS IT NEAR THE MIDLINE?
DOES IT HAVE A “STARRY SKY” APPEARANCE?
ARE THERE ENLARGED LYMPH NODES?
DO THE LYMPH NODES HAVE PRESERVED ARCHITECTURE?
DO THE LYMPH NODES CONTAIN CALCIFICATIONS?
DO THE LYMPH NODES HAVE ABNORMAL ARCHITECTURE?
Deep Neck Masses
Does It Involve the Sternocleidomastoid Muscle?
Is It Paraspinal, and Does It Contain Calcifications?
Does It Appear Locally Aggressive?
Does the Mass Contain Macroscopic Fat?
Is the Mass Well Circumscribed and Hypervascular?
Is the Lesion Multicystic and Transspatial?
Is There Expansion of the Nerve Roots?
Are There Rim-Enhancing Fluid Collections Involving the Tonsils?
Are There Rim-Enhancing Fluid Collections Involving the Retropharyngeal Space?
Summary
9 - Spine
28 - Imaging of the Pediatric Cervical Spine
Mechanism of Trauma
Patterns of Cervical Spinal Injury
Cervical Spine Developmental Anatomy and Normal Variants
Vertebral Body Shape Developmental Changes
Ossification Patterns of the Cervical Spine Vertebrae
C1 (Atlas)
C2 (Axis)
C3–C7 Vertebrae
Craniocervical Junction and Ligaments
Transverse Ligament
Alar Ligament
Apical Ligament
Tectorial Membrane
Anterior Atlantooccipital Membranes
Posterior Atlantooccipital Membrane
Clearance of the Cervical Spine
Clinical Presentation of CSI
Diagnostic Imaging of CSI
Plain Radiography
Flexion and Extension Lateral Views
PREVERTEBRAL SOFT TISSUES
ATLANTODENTAL INTERVAL
C1 SPREAD OR PSEUDOSPREAD
PSEUDOSUBLUXATION
INTERSPINOUS DISTANCE
Computed Tomography
Magnetic Resonance Imaging
Specific Cervical Spine Injuries
Atlantooccipital Dislocation or Craniocervical Dissociation
Imaging Evaluation
Plain Radiography and Computed Tomography
Computed Tomography
Condylar Gap Method or Condyle–C1 Interval
Magnetic Resonance Imaging
Ligamentous Injury
Atlantoaxial Rotary Subluxation
Imaging Evaluation
Plain Radiography
Computed Tomography
Magnetic Resonance Imaging
C1 Vertebra Fractures
C2 Vertebra Fractures
Hangman Fracture (Pars Interarticularis Fracture)
Synchondrosal Fractures
Odontoid Fractures
Subaxial C3–C7 Fractures
Predisposing Conditions to Cervical Spine Injury
Down Syndrome
Os Odontoideum
Klippel- Feil Syndrome
Achondroplasia
Summary
29 - Neonatal Spine Imaging
Neonate With a Non- Skin- Covered Bump/Lesion at the Back
Neonate With a Skin- Covered Bump/Lesion at the Back
Neonate With a Midline Fluid- Discharging Skin Pit
Neonate With Hypoplastic Lower Extremities
Neonate With a Congenital Caudal Tumor
Neonate With a “Duplicated” or Widened Spinal Canal
Neonate With a Focal Scoliosis or Hyperkyphosis
Additional Rare Spinal Abnormalities
Neonate With a Spinal Injury
Neonate With Nonaccidental Spinal Injury
Summary
30 - Imaging of Back Pain
Clinical Evaluation
Imaging Evaluation
Radiographs
Advanced Imaging: Computed Tomography, Magnetic Resonance Imaging, and Nuclear Medicine
Computed Tomography
Magnetic Resonance Imaging
Technetium-99m Bone Scan Whole Body With Single-Photon Emission Computed Tomography Spine
Spondylolysis and Spondylolisthesis
Disk Calcification
Scheuermann Disease/Kyphosis
Sacral Meningocele
Disk Degeneration and Herniation
Disk Cyst
Infectious Disorders
Spondylodiskitis
Epidural Abscess
Chronic Recurrent Multifocal Osteomyelitis/Chronic Noninfectious Osteomyelitis
Neoplastic Disorders
Spinal Column Tumors
Langerhans Cell Histiocytosis
Aneurysmal Bone Cyst
Osteoid Osteoma
Osteoblastoma
Ewing Sarcoma
Lymphoma and Leukemia
Intramedullary Tumors
Astrocytoma
Ependymoma
Extramedullary Intradural Tumors
Schwannoma
Meningioma
Summary
Acknowledgments
INDEX
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
Y
IBC